AccountId: 011433970860
ContactId: b938a5a7-6105-43b0-b229-5c23239df6b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426989 ms
Total Talk Time (AGENT): 134133 ms
Total Talk Time (CUSTOMER): 161289 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/b938a5a7-6105-43b0-b229-5c23239df6b3_20250603T19:00_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Skin and Cancer Associates. How are you doing today?
[AGENT][POSITIVE] I'm good. How are you, Solo?
[CUSTOMER][POSITIVE] I'm also doing good, thank you for asking. And I'm calling to check the claim status.
[AGENT][NEUTRAL] Um, yes, sir. I can assist you with claim status. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, before I proceed with that, please be informed that this call has been recorded for quality and training purpose. Would you like us to continue the recording?
[AGENT][POSITIVE] Um, yes, we can continue.
[CUSTOMER][POSITIVE] Thank you. And my good callback number is [PII] and it is a direct line.
[AGENT][NEUTRAL] OK, thank you. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Yes, uh, before I go with the policy number, may I know your good name, please?
[AGENT][NEUTRAL] Um yes, my name is [PII]. It's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for that. And the policy number is
[CUSTOMER][NEUTRAL] 01960608 M as in Mary, L as in Lima, and number 8.
[AGENT][NEUTRAL] OK. Thank you solo. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, the patient's first name is [PII] and the last name is Please.
[CUSTOMER][NEUTRAL] And the date of birth is [PII], uh sorry, [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Uh, the date of date of service is [PII] and the total bill amount is $536 even.
[AGENT][NEUTRAL] OK, one moment, please.
[AGENT][NEUTRAL] OK. Thanks for your patience. Yes, I'm showing that we received this claim on [PII].
[AGENT][NEUTRAL] And it processed on [PII].
[AGENT][NEUTRAL] The claim number is 358-6166.
[AGENT][NEUTRAL] And I'm showing that it paid out for $109.24.
[AGENT][NEUTRAL] And the first line on the claim denied the 99204 because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Office digits are not covered under the policy?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh, can you please recheck the CPTs because we, as we build this 99214 with modified 25.
[AGENT][NEGATIVE] Yes, it's still not covered. And I'm showing that it was billed with 99204, but it's still not covered as long as it falls under office visits, it's not covered under the policy.
[CUSTOMER][NEUTRAL] Office visits are not covered under this policy.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] The co-pay for the office visit. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Co-pay for office visit?
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] Uh, can I get the call reference for this number?
[AGENT][NEUTRAL] Um, for the call reference number, you can use my name and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Yes, uh, I do also have another claims with the same issue. Can you please help me with that?
[AGENT][NEUTRAL] Um, is it for the same member?
[CUSTOMER][NEUTRAL] No, for the different number?
[AGENT][NEUTRAL] Um, yes, sir. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The next policy number is 024542.
[CUSTOMER][NEUTRAL] 71
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, and number 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, member's first name is?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Yes. It is [PII] and the total bill amount is $385 even.
[AGENT][NEUTRAL] OK, yes, we received this claim on [PII]. Um, the claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 357-517-5.
[AGENT][NEGATIVE] And it paid out for $80 and yes, line one also on this claim denied because office visits, well, the co-pay for office visits is not covered under the policy.
[CUSTOMER][POSITIVE] Uh, thank you, E. Thank you for your information. So we do have uh uh some 10 to 15 claims with the same.
[CUSTOMER][NEUTRAL] Reason we did not receive payment for the office visits. Uh, for, can we take one account uh one account reference and can we
[CUSTOMER][NEUTRAL] Uh, charge this amount from the patients.
[AGENT][POSITIVE] Yes, sir, you can.
[CUSTOMER][NEUTRAL] Uh, we can take any one account reference and can we, uh,
[CUSTOMER][NEUTRAL] Just start this from patients, right?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you. Uh, thank you for your information.
[AGENT][NEUTRAL] OK, thank you, [PII] for calling APL. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][POSITIVE] OK. Well, I thank you again for calling APL and you have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Thank you. uh.